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Volume 28, Number 3—March 2022
Research

Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia

Heda M. Nataprawira1, Fajri Gafar1Comments to Author , Nelly A. Risan, Diah A. Wulandari, Sri Sudarwati, Ben J. Marais, Jasper Stevens, Jan-Willem C. Alffenaar, and Rovina Ruslami
Author affiliations: Hasan Sadikin Hospital, Bandung, Indonesia (H.M. Nataprawira, N.A. Risan, D.A. Wulandari, S. Sudarwati); Universitas Padjadjaran, Bandung, Indonesia (H.M. Nataprawira, N.A. Risan, D.A. Wulandari, S. Sudarwati, R. Ruslami); University of Groningen, Groningen, the Netherlands (F. Gafar, J. Stevens); Children’s Hospital at Westmead, Sydney, New South Wales, Australia (B.J. Marais); University of Sydney, Sydney (B.J. Marais, J.-W.C. Alffenaar); Westmead Hospital, Sydney (J.-W.C. Alffenaar)

Main Article

Table 4

Multivariate Cox proportional-hazards regression model for factors associated with in-hospital death in children treated for TBM at Hasan Sadikin Hospital, Bandung, Indonesia, 2011–2020*

Variable Died†‡ Alive† Crude HR (95% CI) p value aHR (95% CI) p value
No. cases
 44
 231
Age, y
<2 13 (29.5) 78 (33.8) 0.78 (0.37–1.67) 0.527 0.78 (0.36–1.68) 0.522
2–4 11 (25.0) 47 (20.3) 1.04 (0.47–2.29) 0.992 0.93 (0.41–2.12) 0.867
5–9 6 (13.6) 43 (18.6) 0.65 (0.25–1.70) 0.384 0.41 (0.15–1.11) 0.079
10–14
 14 (31.8)
 63 (27.3)
 Referent
Referent
Sex
M 29 (65.9) 118 (51.1) 1.72 (0.92–3.20) 0.089 2.10 (1.09–4.05) 0.027
F
 15 (34.1)
 113 (48.9)
 Referent
Referent
TBM stage§,¶
Stage I 2 (4.5) 54 (23.4) Referent Referent
Stage II 15 (34.1) 111 (48.1) 3.53 (0.81–15.44) 0.094 2.57 (0.58–11.41) 0.214
Stage III
 27 (61.4)
 66 (28.6)
 9.16 (2.18–38.51)
 0.003
 5.96 (1.39–25.58)
 0.016
Parents’ monthly income#
USD ≤140 33 (75.0) 136 (58.9) 2.79 (1.17–6.67) 0.021 2.59 (1.06–6.31) 0.036
USD >140 6 (13.6) 74 (32.0) Referent Referent
Unknown
 5 (11.4)
 21 (9.1)
 2.73 (0.83–8.95)
 0.097
 2.04 (0.59–7.02)
 0.261
Known BCG vaccination
No 15 (34.1) 44 (19.0) 2.01 (1.08–3.76) 0.028 1.97 (1.03–3.76) 0.040
Yes
 29 (65.9)
 187 (81.0)
 Referent
Referent
Hydrocephalus on CT¶
No 12 (27.3) 133 (57.6) Referent Referent
Yes** 22 (50.0) 76 (32.9) 3.00 (1.48–6.05) 0.002 2.32 (1.13–4.79) 0.022
Unknown
 10 (22.7)
 22 (9.5)
 4.38 (1.89–10.13)
 0.001
 4.21 (1.77–10.01)
 0.001
Seizures on admission¶
No 13 (29.5) 112 (49.5) Referent Referent
Yes 31 (70.5) 119 (51.5) 2.09 (1.09–3.99) 0.026 1.96 (1.01–3.82) 0.048

*Values are no. (%) except as indicated. aHR, adjusted hazard ratio; BCG, bacillus Calmette-Guérin; CT, computed tomography; GCS, Glasgow Coma Scale; IDR, Indonesian Rupiah; TBM, tuberculous meningitis. †Including patients who died or had recovered (with or without disability) on hospital discharge, and excluding patients who had persistent vegetative state or discharged against medical advice. ‡Signs of upper motor neuron lesion was associated with an increased risk of in-hospital death in univariate analysis, but did not remain significant in multivariate analysis. Signs of raised intracranial pressure with hydrocephalus as well as GCS score with TBM stage had the likelihood of collinearity; therefore, only hydrocephalus and TBM staging were included in the final multivariate model. For HIV coinfection, although it was significantly associated with in-hospital death in univariate analysis, we did not include this variable in multivariate analysis due to the selective HIV testing and a very low number of patients with HIV positive (n = 4). §Stage I TBM was defined as GCS of 15 with no focal neurologic signs, stage II TBM as GCS of 11–14 or 15 with focal neurologic signs, and stage III TBM as GCS ≤10 (20). ¶TBM staging might interact with hydrocephalus and seizures on admission; however, due to the low number of patients with stage I TBM who died during hospitalization (n = 2), these potential interactions could not be assessed in the Cox regression model. #Parents’ monthly income was estimated based on the current provincial minimum wage for West Java (IDR 1.810.350,00, rounded up to IDR 2.000.000,00, equal to approximately USD 140). **In-hospital death among children with hydrocephalus was not significantly different between those who received neurosurgical intervention and who did not receive neurosurgical intervention (p = 0.604).

Main Article

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1These first authors contributed equally to this article.

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